Impaired bone and muscle development in young people treated with antiepileptic drugs

Summary Objective Antiepileptic drugs (AEDs) are associated with reduced bone density, balance impairment, and increased fracture risk in adults. However, pediatric data are limited. Therefore, we aimed to examine bone, muscle, and balance outcomes in young patients taking AEDs. Methods We undertook...

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Veröffentlicht in:Epilepsia (Copenhagen) Jg. 58; H. 11; S. 1931 - 1938
Hauptverfasser: Simm, Peter J., Seah, Sebastian, Gorelik, Alex, Gilbert, Lauren, Nuguid, Jenning, Werther, George A., Mackay, Mark T., Freeman, Jeremy L., Petty, Sandra J., Wark, John D.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Wiley Subscription Services, Inc 01.11.2017
Schlagworte:
Adolescent
Anticonvulsants - administration & dosage
Anticonvulsants - adverse effects
Antiepileptic agents
Australia - epidemiology
Balance
Body weight
Bone density
Bone Density - drug effects
Bone Density - physiology
Bone mineral density
Cancellous bone
Case-Control Studies
Child
Child, Preschool
Computed tomography
Diseases in Twins - chemically induced
Diseases in Twins - diagnostic imaging
Diseases in Twins - epidemiology
Drug development
Dual energy X-ray absorptiometry
Epilepsy
Epilepsy - diagnostic imaging
Epilepsy - drug therapy
Epilepsy - epidemiology
Female
Fractures
Fractures, Bone - chemically induced
Fractures, Bone - diagnostic imaging
Fractures, Bone - epidemiology
Humans
Male
Muscle Development - drug effects
Muscle Development - physiology
Registries
Siblings
Tibia
Treatment Outcome
Epilepsy
Bone density
Fractures
ISSN:0013-9580, 1528-1167, 1528-1167
Online-Zugang:Volltext
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Zusammenfassung:Summary Objective Antiepileptic drugs (AEDs) are associated with reduced bone density, balance impairment, and increased fracture risk in adults. However, pediatric data are limited. Therefore, we aimed to examine bone, muscle, and balance outcomes in young patients taking AEDs. Methods We undertook a case–control study utilizing an AED exposure–discordant matched‐pair approach. Subjects were aged 5–18 years with at least 12 months of AED exposure. Pairs were twins, nontwin siblings and first cousins, sex‐ and age‐matched (to within 2 years), allowing for greater power than with unrelated control subjects. Dual energy x‐ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), and muscle force/balance were tested, with questionnaires were administered for bone health and epilepsy details. Results Twenty‐three pairs were recruited, (median age 12.9 years [subjects] and 13.5 years [controls])—7 twin, 14 sibling, and 2 cousin pairs. Those taking AEDs had an increased prevalence of fractures (15 fractures in 8 subjects, compared with 4 fractures in 3 controls, p < 0.01). Trabecular volumetric bone mineral density (vBMD) measured by pQCT at the 4% site (tibia) was reduced by 14% (p = 0.03) in subjects. Subjects exerted a decreased maximum force compared to body weight (Fmax total/g) at the tibia. There were no differences seen in either bone mineral parameters measured by DXA or balance measures. Significance Young people taking AEDs reported more fractures and had reductions in tibial vBMD and lower limb muscle force compared to their matched controls. These findings suggest that further exploration of bone health issues of young patients on AED therapy is required. Longitudinal studies are required to confirm these changes in the muscle–bone unit and to further explore the clinical outcomes.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0013-9580
1528-1167
1528-1167
DOI:10.1111/epi.13893